This transfer is for:* Athlete Nonathlete

Is this a transfer from one CT club to another CT club?* Yes No

Is this a transfer from a club outside the state of CT?* Yes No

Last Name:*

First Name:*

Middle Name. If none, enter None:*

Nickname or Preferred Name:

Address:

City:

State:

Zipcode:

Date of BIrth mm-dd-yyyy:*

Gender:* Male Female

Name of LSC and club you are leaving:*

Name of CT club you are transferring to:* AJSC ARAC BEAR BSY BULL CAC CAT CCSU CDOG CPAC FFLY FINS FVYT GLAS GRIT GRYM GWYB GYWD HHAC HMST HNHS HNHY ICSC IVY LEHY LST MAC MJCC MSC NCA NCY NFAF NMBS NMEG NSC NWYL OAK OXO PAC PSDY RAC RAYS RYWC SAQ SEAL SHKS SJCC SLAC SMST SOCO SSAC SWAT SYS TAC TP UCON UN VSYM WAC WEST WFYD WHAT WOLF WRAT WRTS WWRX WYW YALE YCST ZEUS

Name of person responsible for this transfer request:*

Email:*

Phone:

Please allow 1-2 business days for processing.

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